Provider Demographics
NPI:1073129458
Name:BLOOM GYNECOLOGY LLC
Entity type:Organization
Organization Name:BLOOM GYNECOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:SARA
Authorized Official - Middle Name:CHRISTINE
Authorized Official - Last Name:NORTHROP
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:817-542-5912
Mailing Address - Street 1:450 HAWKINS RUN RD STE 1
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:TX
Mailing Address - Zip Code:76065-6670
Mailing Address - Country:US
Mailing Address - Phone:682-900-1040
Mailing Address - Fax:682-847-7520
Practice Address - Street 1:450 HAWKINS RUN RD STE 1
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:TX
Practice Address - Zip Code:76065-6670
Practice Address - Country:US
Practice Address - Phone:682-900-1040
Practice Address - Fax:682-847-7520
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-21
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Single Specialty